Provider Demographics
NPI:1083040893
Name:LUSBY, MEGAN LAUREN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LAUREN
Last Name:LUSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BRYAN STATION RD STE 122
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2139
Mailing Address - Country:US
Mailing Address - Phone:859-293-6133
Mailing Address - Fax:859-293-6730
Practice Address - Street 1:1650 BRYAN STATION RD STE 122
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2139
Practice Address - Country:US
Practice Address - Phone:592-936-1338
Practice Address - Fax:859-293-6730
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT28680225100000X
KY007955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100735490Medicaid